Understanding Hirschsprung's Disease: Symptoms, Diagnosis, and Treatment

Creator: Doctronic
Published: 2023-05-21

Medically reviewed by Jerome Albert Ecker | MD, Assistant Professor of Medicine, Duke University - Durham, NC on May 21st, 2023.

Key Takeaways

This congenital condition occurs when neural crest cells fail to migrate completely during weeks 5-12 of fetal development, leaving segments of colon without the nerve cells needed for peristalsis.
Newborns typically fail to pass meconium within 48 hours of birth, and 90% of cases are diagnosed within the first year when classic symptoms like chronic constipation and abdominal distension appear.
Boys are affected 4 times more frequently than girls, and the condition co-occurs with Down syndrome in 12% of cases and other genetic syndromes in about 18% of patients.
The gold standard pull-through surgery involves removing the aganglionic bowel segment and connecting healthy intestine directly to the anus, with most procedures performed laparoscopically in the first 6-12 months of life.
Post-surgical outcomes show 85-90% of children achieve good bowel control by school age, though some may experience enterocolitis complications requiring antibiotic treatment and careful monitoring.

Hirschsprung's disease is a congenital condition that affects newborns, causing problems with bowel movements. Although it can be a serious condition, modern medicine has made it possible for children with Hirschsprung's disease to live relatively normal and healthy lives with proper treatment.

What is Hirschsprung's Disease?

Hirschsprung's disease is a disorder that develops during pregnancy and is present at birth. It occurs when nerve cells in the large intestine are missing, which can cause difficulty with bowel movements. The disease is named after the 19th-century Danish doctor Harald Hirschsprung, who first described the condition in 1888.

Causes of Hirschsprung's Disease

The exact cause of Hirschsprung's disease is unknown, but researchers believe it is related to flaws in DNA instructions. In a baby with Hirschsprung's, the nerve cells stop growing at the end of the large intestine, just before the rectum and anus. This means the body can't sense when waste material reaches a certain point, causing a blockage in the digestive system.

Risk Factors

Hirschsprung's disease affects about one in every 5,000 newborns
Children with other congenital conditions, such as Down syndrome and heart defects, are more likely to have the disease
Parents who carry the code for Hirschsprung's disease in their genes, especially mothers, may pass it on to their children
Boys are more likely to have Hirschsprung's disease than girls

Symptoms of Hirschsprung's Disease

For the vast majority of people with Hirschsprung's disease, symptoms usually begin within the first 6 weeks of life. In many cases, there are signs within the first 48 hours. Some common symptoms include:

No bowel movements in the first couple of days of life
Swelling in the abdomen
Bloody diarrhea
Vomiting (may be green or brown)
Chronic constipation in older children
Growth issues and fatigue in older children

Understanding Hirschsprung's Disease: Symptoms, Diagnosis, and Treatment

Diagnosis and Tests for Hirschsprung's Disease

If your child has symptoms of Hirschsprung's disease, it's important to tell your doctor at once. They can confirm the diagnosis with specific tests, such as:

Contrast enema (also called a barium enema)
Abdominal X-ray
Biopsy of rectal tissue
Anorectal manometry (for older children)

Treatment Options for Hirschsprung's Disease

Hirschsprung's disease is a very serious condition, but if found quickly, it can be treated effectively. The main treatment options are:

Pull-through procedure: This surgery removes the part of the large intestine with the missing nerve cells and connects the rest of the intestine directly to the anus.
Ostomy surgery: This surgery routes the intestine to an opening made in the body and attaches an ostomy bag to the outside of the opening to hold the waste from the intestine. This is usually a temporary measure until the child is ready for the pull-through procedure.

After Surgery

After surgery, some children may experience issues with constipation, diarrhea, or incontinence. A small number may develop enterocolitis, a life-threatening infection of the colon. If this happens, take your child to the hospital immediately. However, with proper care, especially a proper diet and plenty of water, these conditions should subside, and most children are able to experience normal bowel movements within a year of treatment.

It's important to remember that Hirschsprung's disease is a lifelong issue that should be monitored. Some children may have bowel issues on and off into adulthood. If you suspect your child has Hirschsprung's disease or if they have been diagnosed with the condition, work closely with your healthcare provider to ensure the best possible outcome.

Additional Resources

The Bottom Line

Early surgical correction within the first year typically restores normal bowel function for most children, though lifelong follow-up ensures optimal outcomes. If your newborn hasn't passed stool within 48 hours or shows signs of severe abdominal swelling, getting prompt medical evaluation is crucial—Doctronic can help you understand these symptoms and connect with appropriate care quickly.